"All human beings should be able and willing to perform basic maintenance on themselves." -Kelly Starrett
Injuries can be very frustrating. They always seem to come along when you are making good progress in the gym and settling into a nice routine. When you hurt yourself it can set you back from months of progress and be very demotivating. I want to talk about the 3 biggest injuries that we see and what you can do to prevent them or to get over them as quickly as possible.
Let's start by talking about what I mean by injury. What I am not talking about is a trauma injury. This would be characterized by something major happening during an exercise or movement and causing major immediate pain. This is something that we have rarely ever seen and is typically something that requires surgery or major physical therapy to fix. This might be a torn ligament or cartilage, or might be a serious muscle pull or tear. These types of injuries are typically something where you know it when it happens-there is an instance of pain and then your body cannot function the same after. In these instances it is always best to see a doctor or specialist and take all precautions needed. What I am talking about in this article are those minor injuries that can become major. These are the injuries where you wake up in the morning feel like you slept wrong. You aren't sure what you did but you're starting to feel some pain. If left unattended it can start to get worse over time. It will start limiting what you can do in the gym. It might hurt during certain movements and not during others, and typically once you get warm it gets better or goes away. These are the nagging injuries that can really zap your progress and your motivation.
The first step is to start changing the way you look at this pain. Pain is simply your bodies way of trying to tell you something. Something in how you are moving or what you are doing is off and your body is trying to get your attention. One of the biggest things that has helped me over the year is to stop looking at these things as injuries. I'm not hurt, something is just out of tune and needs to be adjusted. My body just needs a little maintenance work. The sooner you grasp this concept the sooner you will learn to take care of your body the way it was meant to be cared for.
So what causes these types of injuries? I have gone in depth on this topic in a previous article but there are several causes. One can be overuse (or under recovery). You do a lot of work and then your body doesn't recover enough before the next session. This can come from lack of sleep, lack of enough nutrients from diet, or just plain overdoing it. Another can be overusing certain muscles. I will get into this a little more specifically for each injury but basically this involves overusing smaller muscles that were not meant to perform the bulk of the work, instead of using the bigger muscles who were. This is caused by lack of range of motion of a joint, not allowing us to access the muscles needed for a given movement. I will explain this in depth in each section. Basically, most injuries come from overusing the wrong muscles for a movement because of a lack of range of motion. Clear as mud right? Let's break this down a little more by talking about the three main things we see.
1. Shoulder issues
The most common issue we see is shoulder pain. Typically this starts the day following a lot of upper body work and can linger for a while. It typically hurts somewhere in the front or the side of the shoulder (but can move around from person to person), but is generally caused by a lack of internal range of motion in the shoulder. When we are missing range of motion in the shoulder we can't fully engage our lats (the biggest muscles of our upper body) to perform movements that we need them for. These can be pullups, but also can be any shoulder to overhead movement, overhead stability moments (overhead squats), anything in the front rack, or even pushups and bench press. When we can't fully use our lats we overuse the much smaller teres muscle above it. This can also be caused by over dominant traps. As the traps do too much work they pull the shoulders up and forward, not allowing us to use our lats. These teres muscles can get overworked very quickly, causing them to tighten up. This tightening causes inflammation where the muscles connect to the ligaments of the shoulder (typically in the side or front). This can be very frustrating, because where you are feeling the pain isn't what is actually causing the pain. So what do we do about it?
The first step is to loosen up the teres and the traps. I like to use a lacrosse ball on my teres by laying on my side and putting the ball in the back of my armpit with my arm reaching up. For the trap my favorite is to take an empty barbell and place it over the trap, holding it in place with the opposite hand. Turning the head away from the barbell can allow the bar to really get deep into the tissue. When you are working on these spots it is best to move the ball and bar around until you find a spot that really hurts. You will know when you find it-it typically feels like you're getting jabbed with a knife. A few minutes 3-5 times a day for a few days and typically the inflammation will be gone.
One you have gotten the inflammation out it is now time to work on improving range of motion and strengthening the upper back. We need to increase our internal and external rotation of our shoulders, as well as to develop our upper back and lower trap muscles to keep our shoulders pulled back and down. There are tons of exercises to do for both of these so a simple google search will suffice (or ask a coach). Also being mindful of how you sit and stand can make a huge difference. We are so used to sitting with our shoulders rolled forward that simply trying to keep our shoulders back as much as possible throughout the day can make a huge difference.
2. Low Back Pain
Low back pain is another frequent issue that we see with people, especially when they are first starting out. Similar to the shoulder issues, this typically occurs the day after a lot of posterior chain work (rowing, squatting, running, jumping, etc.). Why does this happen? Similar to the shoulder issues, this is typically caused by a lack of range of motion in the hips. A lack of internal range of motion of the hip keeps us from accessing our glutes when we perform movements. Instead of using the gluteus maximus (which is supposed to be the biggest, most powerful muscle of our body), we end of using our piriformis, a much smaller muscle at the top of our butt. These muscles can get overworked very quickly, and similar to the shoulder they tighten up, causing them to cause inflammation in our lower back. This is always frustrating for people when they think that they have hurt their back (which has a very negative connotation that goes with it) when really they have just strained the a muscle in their butt.
So what should you do? The first step, like the shoulder, is to get the inflammation out by loosening the muscle. I like the lacrosse ball for this by sitting on the ball with the same leg crossed over the other and leaning to the side. Once again you will know the spot when you find it. A couple of minutes 3-5 times a day will have your back feeling much better after a few days. After the pain has subsided it is time to start improving the range of motion of your hips. My favorite stretch for this is the 90/90 stretch, making sure to really focus on reaching for that back leg and improving the internal range of motion of your hips. You can google this or ask a coach (we also do this all the time in class). We also need to strengthen those glutes (I like to say we need to turn those gluteus minimimuses into maximuses…). Single leg work, such as step ups, lunges, glute bridges, and many others can help us to develop those glutes so that they become the big movers of our lower bodies that they were supposed to be.
A final thing to keep in mind with low back pain is that many times a weak core can be a big contributor as well. With as much time as we spend sitting in modern life our core can get very weak. Adding in some plank holds and midline stability can go a long way to strengthening our core, taking pressure off of our low back when we exercise.
3. Knee Pain
The third issue we see the most of is knee pain. There are two different types of knee pain and they both require different treatments. The first is pain at the bottom of the knee (also known as jumpers knee) and the second is pain at the top of the knee. Both of these have the same cause (lack of internal rotation of the hip), but manifest themselves in different ways. Bottom of the knee pain is caused by the knee coming in slightly when we squat or jump, causing the inside of the quad to get overworked. Top of the knee pain comes from lack of glute engagement when we squat, causing the outside quad to get overworked. Both of these cause inflammation of the knee.
So what do we do? If the bottom of the knee is hurting then I like to lacrosse ball the inside of the quad towards the bottom of the leg. If the top of the knee is hurting I like to work on the outside of the quad in the middle or towards the top of the leg. Just like previously keep moving the ball around until you find the spot that really hurts. A couple of minutes 3-5 times a day for a few days should knock out most of the inflammation. After that the fix is going to be the same as for the lower back. Work on improving the range of motion of the hips so that you can use your glutes better when you run, jump, or squat. Single leg work to develop those muscles will keep the issue from coming back down the road.
Those are the three main issues that we see, but are not all of them. The same principals can be applied to any pain issue. Whenever you are having pain think about a few things. What movement was I doing that caused the pain to start? What muscles am I using that might be overworked? What tool can I use to loosen those muscles and get blood flow to the tight and injured area (lacrosse ball, barbell, elbow, etc.)? What range of motion do I need to improve so that I use the correct muscles when doing this movement pattern? What movement can I do to strengthen the correct muscles? It takes a lot of practice but eventually you CAN become in tuned with your body so that you know when something is off and what you need to do to fix it. As always, when in doubt ask a coach. They can help you out or point you in the direction of someone who can. Remember, if you start to think of this as maintenance as opposed to an injury then you will change your mindset towards pain. Pain is just your bodies way of telling you something is off. If you can learn to listen to it than it can drastically improve your fitness and longevity.